According to the American Cancer Society in 2014, about 585,720 Americans are expected to die of cancer, almost 1,600 people per day. Cancer is the second most common cause of death in the US, exceeded only by heart disease, accounting for nearly one of every four deaths. This disease affects people of all ages, and treatment options currently include surgery, radiation therapy, immunotherapy, cryotherapy, laser therapy, and chemotherapy. Surgery, alone or in conjunction with other treatments, is used in more than nine out often cases. Prostate cancer is the most common non-skin malignancy in men and the second leading cause of cancer death. The ACS estimates over 230,000 new cases in 2015, the majority of which will have localized disease. Most of these men will receive radical prostatectomy (RP) or external beam irradiation (EBRT).
Benign enlargement of the prostate (BPH) refers to the nonmalignant growth of the prostate observed very commonly in aging men. The histologic prevalence of BPH, which has been examined in several autopsy studies around the world, is approximately 20% for men in their 40s, reaches 50% to 60% for men in their 60s, and is 80% to 90% for men in their 70s and 80s. The condition becomes a clinical entity if and when it is associated with subjective symptoms, the most common manifestation being lower urinary tract symptoms (LUTS). Typically the patient will seek medical care because of these symptoms or because of an inability to urinate. The evaluation, often done by a urologist, will reveal the enlarged gland, and a number of treatment options will be proposed, including medical therapy (α-adrenergic receptor blockers and 5α-reductase inhibitors), minimally invasive therapies (transurethral microwave therapy (TUMT) and transurethral needle ablation (TUNA)), and surgery (transurethral resection of the prostate (TURP) and open prostatectomy). The latter therapies are often reserved for men with very large prostates.
Prostatitis describes a combination of infectious diseases (acute and chronic bacterial prostatitis), chronic pelvic pain syndrome, and asymptomatic inflammation. Its prevalence ranges from 2.2 to 9.7% of the male population. Prostatitis has been diagnosed in 1% of all primary care physician visits and in 8% of all visits to urologists. In a survey of 31,681 men, 16% had a self-reported history of prostatitis. Participants reporting a history of benign prostatic hyperplasia (BPH) had 7.7-fold greater odds of a history of prostatitis, those with severe lower urinary tract symptoms had 2.8-fold greater odds of a history of prostatitis, and men with moderate lower urinary tract symptoms had 1.8-fold greater odds of prostatitis. According to the National Institutes of Health, prostatitis accounts for 25% of all office visits involving the genitourinary system by young and middle-aged men. Despite the fact that prostatitis can be caused by common colon bacteria, in only 5-10% of the cases can bacteria be cultured. Therefore, the overwhelming majority of cases are caused by an idiopathic inflammatory process. After a trial of antibiotics, which are usually not successful, analgesics and warm baths are recommended to alleviate symptoms of prostatodynia (painful prostate) and nonbacterial prostatitis.
Uterine fibroids (leiomyomata) are noncancerous growths that develop in or just outside a woman's uterus. Uterine fibroids develop from normal uterus muscle cells that start growing abnormally. As the cells grow, they form a benign tumor. Fibroids are extremely common and when large are associated with prolonged menstrual periods, heavy bleeding during periods, bloating or fullness or pain in the abdomen or pelvis, constipation, and pain with intercourse. Fibroids can be detected by a physical exam or imaging (usually ultrasound). A number of non-surgical options for treating symptomatic fibroids include hormones (estrogen, progesterone, or a combination) which can help reduce heavy periods caused by uterine fibroids, Lupron, which stops menstrual periods and shrinks uterine fibroids, and an intrauterine device (IUD) with levonorgestrel which reduces heavy periods. Surgical options include myomectomy, which removes uterine fibroids while leaving the uterus in place, and hysterectomy to remove the entire uterus and all uterine fibroids and can be done by an open or laparoscopic procedure. Hysterectomy is the second most frequently performed surgical procedure (after cesarean section) for U.S. women. Approximately 600,000 hysterectomies are performed annually in the United States, and approximately 20 million American women have had a hysterectomy. Women who are not surgical candidates can undergo uterine artery embolization (UAE), a procedure that cuts off blood flow to a uterine fibroid, causing it to shrink. This procedure is associated with substantial pain and/or discomfort.
While surgery and radiation are the most common treatments for these diseases, they are associated with significant side effects and long-term decrease in quality of life. In addition, surgery or radiation are not used for prostatitis. Patients are seeking less invasive methods of treatment where only the lesion(s) are treated and the majority of the gland or organ is left in-tact. In men with prostate cancer, upwards of one in three (over 80,000 men) are candidates for focal therapy, where just the lesion is treated and the surrounding “normal” tissue is spared. For men with prostatitis, surgery or radiation have not been an option, and the majority of patients continue to have symptoms.
Melanoma is a type of skin cancer which forms from melanocytes (pigment-containing cells in the skin). In women, the most common site is the legs, and melanomas in men are most common on the back. It is particularly common among Caucasians, especially northern Europeans and northwestern Europeans, living in sunny climates. There are higher rates in Oceania, North America, Europe, Southern Africa, and Latin America. This geographic pattern reflects the primary cause, ultraviolet light (UV) exposure in conjunction with the amount of skin pigmentation in the population. Melanocytes produce the dark pigment, melanin, which is responsible for the color of skin. These cells predominantly occur in skin, but are also found in other parts of the body, including the bowel and the eye (see, uveal melanoma). Melanoma can originate in any part of the body that contains melanocytes.
Treatment of melanoma includes surgical removal of the tumor. If melanoma is found early, while it is still small and thin, and if it is completely removed, the chance of cure is high. The likelihood that the melanoma will come back or spread depends on how deeply it has gone into the layers of the skin. For melanomas that come back or spread, treatments include chemo- and immunotherapy, or radiation therapy. Five year survival rates in the United States are on average 91%.
Melanoma is less common than other skin cancers. However, it is much more dangerous if it is not found in the early stages. It causes the majority (75%) of deaths related to skin cancer. Globally, in 2012, melanoma occurred in 232,000 people and resulted in 55,000 deaths. Australia and New Zealand have the highest rates of melanoma in the world. It has become more common in the last 20 years in areas that are mostly Caucasian. There is a great need for more effective treatment methods for melanoma.